Royal Town Planning Institute

1

APPLICATION FOR RTPI STUDENT MEMBERSHIP – TOWN PLANNING APPRENTICE

1. Personal information *

Title: Ms ☐ Miss ☐ Mrs ☐ Mr ☐ Dr ☐ Other (please specify):
Surname:
Forename:
Address:
Postcode: / Daytime telephone number:
College email address (if applicable):
Personal email address:

*all personal details are mandatory and must be in capitals

2. Education

College:
Title of apprenticeship: Town Planning Technical Support ( Level 3)
Date of commencement:
Date of successful/expected completion of apprenticeship:

Employment details

Employer name:
Address:
Postcode:
Phone number:
Work email address:

3. Free Student membership eligibility

*From 1 September 2014, all students on RTPI accredited courses are eligible for free Student membership*

Are you eligible for free student membership? Yes ☐x No ☐
Are you a current student member? Yes ☐ No ☐x
If yes, please provide membership number:

4. Declaration by applicant

I wish to be elected as a Student Member of the Royal Town Planning Institute. I promise that if I am elected Iwill abide by and observe the provisions of the Royal Charter and Byelaws and the Code of Professional Conduct, that I will pay the appropriate subscriptions for my class and will work to promote the objectivesof the Chartered Institute.

Signature:
Date:

5. Declaration by Learning Provider (FREE STUDENT MEMBERSHIP ONLY)

I declare that the applicant is a student on a RTPI accredited course.

Name:
Job Title:
Name of College:
Signature:
Date:

6. Equality and diversity

The Institute regularly monitors the profile of its membership in order to comply with equality and diversity legislation. Although it is not compulsory to provide the following information, it will be an invaluable aid for the Institute to put in place mechanisms to ensure that its membership is representative of the UK population.

This information will be held on the Institute’s database in accordance with the Data Protection Act 1998. It will be treated confidentially and will not be divulged to other parties.

Date of Birth (DD/MM/YY)
Gender / Male ☐ Female ☐
Under the Equality Act 2010 a disability is a physical or mental impairment; that has a substantial and long-term adverse effect on the ability to carry out normal day-to-day activities.
Do you consider yourself to have a disability in accordance with the Equality Act? / Yes ☐ No ☐
What is your nationality?
I would describe my ethnic origin as:
Asian / Asian British
☐Bangladeshi
☐Chinese
☐Indian
☐Pakistani
☐Any other Asian background, please describe:
Black / African / Caribbean / Black British
☐African
☐Caribbean
☐Any other Black / African / Caribbean background, please describe: / Mixed / Multiple ethnic groups
☐Asian & White
☐Black African & White
☐Black Caribbean & White
☐Any other mixed / multiple ethnic background, please describe:
Other Ethnic Group
☐Arab
☐Any other ethnic group, please describe: / Undisclosed
☐I do not wish to disclose my ethnic origin
White
☐Welsh / English / Scottish / Northern Irish / British
☐Irish
☐Gypsy or Irish Traveller
☐Any other White background, please describe:

7. How to submit your application

By email:

By post:41 Botolph Lane, London EC3R 8DL

Membership queries: or 0207 929 9462

* For more details on Student membership visit:

** Student Application Form is available to download online and complete electronically using the above link